Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. How long do you expect to live? Maybe if I'd asked you this question 100 years ago, you would have said maybe 50. Now, that number seems quite low, right? Hopefully, you're aiming for at least 80 or 90 years of life, or more. Well, we've made great strides toward longer lives in this country, though there's been a reversal of this trend in recent years according to The Washington Post. Have you seen this deep dive article last few days? Life expectancy in the United States is falling, and it's not just COVID to blame. The deep dive article also shows us how life expectancy for different Americans is a dynamic measure of inequality and injustice. One premise is that health is now a better indicator of inequality than wealth. We'll explain.

Joining us now is one of the authors of this piece, Akilah Johnson. She's a reporter focused specifically on the effect of racism and social inequality on health for The Washington Post. Akilah, thanks so much for joining us. Welcome to WNYC.

Akilah Johnson: Thank you for having me.

Brian Lehrer: Can we start with just the top line life expectancy number in the United States before we pick it apart for different groups or compare it to other countries or anything? What's the average life expectancy in the United States, and how much has that top line number average of everybody in the country fallen in recent years?

Akilah Johnson: Well, the most recent number has not been finalized yet, the 2022 number, but when you're looking at 2021, it's like 76.4 years, so about 76 years for the average person in the US. That's what the life expectancy is, and that's the lowest number since the mid-1990s.

Brian Lehrer: If we look back, say, 100 years, like I hypothetically did in the intro, and we picked a number out of the hat, would you have expected to live to 50? Or what do you think the number would have been 100 years ago if your research has given you that?

Akilah Johnson: I mean, at the previous turn of the century-- The turn of the century now is 2000, but if we were going back to the 1900s, it would have been like 47. We've had unimaginable advances in healthcare, and technology, and just our understanding of the human immune system and biology, and so we were really on this course to have life expectancy reach 80 in the US. For a long time, that put us right in the middle of the pack with our peers, and we were marching towards 80, but we have never gotten there.

Brian Lehrer: So the peak was in the '90s, 1990s, and it's been going down ever since?

Akilah Johnson: No, the peak wasn't in the '90s. We peaked, we were going up, and then in the 2000s, the early aughts, we were going up, but then you have a confluence of factors. We tend to focus on drug overdoses and guns, deaths of despair, which are kind of very uniquely American phenomenon which have eroded life expectancy in a lot of ways, but there's a kind of silent epidemic-- And I would put silent in quotes to some extent because there have been a large number of people who have been raising the alarm since like 2013, 2014, 2015, that say chronic conditions are really eroding life in the US, but not a lot of people have really been paying attention. By chronic conditions, we're talking cardiovascular disease, that is like issues of the heart, hypertension, diabetes, obesity is now a big one. Obesity is now a big indicator for cancer diagnoses, so there's just been this confluence of chronic conditions that have been happening in the US that have really been eroding our health.

Brian Lehrer: Now we get to the fact that this trend isn't occurring evenly throughout the country, as your article points out. Where are people living shorter lives, and why is it that certain areas of the country, and I guess we could talk geographic areas, or of course, we could talk demographics, have longer or shorter life expectancies?

Akilah Johnson: Well, there are some geographic differences that have happened. We did a 40-year comparison, and right now what you're seeing is that urban areas really have higher levels of life expectancy than some of your more rural communities. But when you look at the geographical footprint of where early death is, you got these counties in the South and the Midwest where working age people-- so working age people are folks, let's say 35 to 64, are really dying at a higher rate than they were 40 years ago. We have this line in the story, and we realized that--

We say the trail of death is so prevalent that a person could go from Virginia-- if you're in your car and you decide to go on a road trip, and you're driving from Virginia down through Louisiana, and then you decide to shoot up through Kansas, you could do that by traveling entirely through communities where the death rates are now higher than they were when Jimmy Carter was president.

Brian Lehrer: To what degree is it urban versus rural, or maybe even red state versus blue state? If Medicaid availability or other kinds of life supports for people are different in different political environments, tell me if that comes into it.

Akilah Johnson: Oh, that plays a huge part. One of the things that we found in talking to a variety of researchers, and then through our own analysis, is that state politics, kind of state policy, really plays a huge role in who lives and who dies, and the life expectancy and lifespan of folks in states. You tend to see folks in redder states where you have less taxation laws, specifically if we're thinking cigarette taxes, when we think of policies around soda taxes and different things like that, folks in those states have lower life expectancy. If you live in a redder state, and you have fewer taxes and oversight policies, you also have lower life expectancy and lower lifespans.

Brian Lehrer: Did you draw a straight line between higher cigarette taxes and lower cigarette-related death rates in different places?

Akilah Johnson: Some of my colleagues really dug into the state policies, and that was one of the things we found, is that you see a decrease in smoking or less smoking in places where you have higher cigarette taxes. These three counties that sit along Lake Erie in Ohio, Pennsylvania, and New York, if memory serves, they all have drastically different cigarette tax rates, and they all have different levels of lung cancer and lung-related illnesses, and they have vastly different life expectancies, and the life expectancies are higher in the states that charge more for things like cigarettes.

Brian Lehrer: Listeners, who has a question about life expectancy in the United States over time, or today in different regions, or among rich and poor, or other demographic differences, or between the United States and other countries? This deep dive into life expectancy and how we might have expected it to keep going up in a medically advanced country like the United States, but that has not been the case. This is not about COVID, this is not just about the million deaths from this epidemic over the last few years, this is about chronic and long-term patterns over decades in this country published now in The Washington Post. 212-433-WNYC, 212-433-9692 for Post reporter Akilah Johnson who focuses specifically on the effect of racism and social inequality on health for The Post. 212-433-9692.

Let's talk about inequality. You write, "The best barometer of rising inequality in America is no longer income, it is life itself." Can you explain that further?

Akilah Johnson: You know, we quite often talk about how we are an unequal society, and there are these big gaps between income inequality, the wealthy and folks who are not as wealthy. What we see is that in terms of people who live in wealthier communities have vastly higher life expectancies than people who live in communities that are poor, and that is not -- because some people might say, "Well, duh," but then if you also look at and you compare that to some of our peer nations, so we looked at -- I believe it was Japan, France, and Canada, people living in the poorest areas of the US have far lower life expectancies than people living in the poorest areas of those countries. But also, people who live in wealthy areas have lower life expectancies than people who are living in wealthy areas in our peer countries, and so that's really what we're talking about.

It's how much money you make and how you are able to navigate unexpected -- not just unexpected medical bills, but the types of food that you eat, if you have time off if you are sick, if you have health insurance. If you are able to live in a community that you have access to green space where you can work out, where you're not worried about working out and possibly being subject to too much surveillance, air quality, the air quality in your neighborhood. All of those things contribute to your overall health, and so when we think about the difference in income and wealth, all of those factors contribute to your lifespan. That's what we mean by that.

Brian Lehrer: I'm going to read one marquee stat from the article. One line here says, "Wealth and equality in America is growing, but The Post found that the death gap, the difference in life expectancy between affluent and impoverished communities has been widening many times faster." In the early 1980s, The Washington Post article says, early 1980s, people in the poorest communities were 9% more likely to die each year, but the gap grew to 49% in the past decade, and widened to 61% when COVID struck. Even that pre-COVID difference, Akilah, oh my goodness. Going from 9% more likely to die each year in the poorest communities to 49%, it's mind-boggling.

Akilah Johnson: It is mind-boggling. One of the things that COVID did is, not only did it exacerbate problems that were already existing, it really shone a light on what was happening for a lot of folks. We have an expert, Marcella Nunez-Smith, who describes it kind of as the not so -- Like, in terms of chronic conditions, the not-so-silent pandemic that has been happening, and how people really get with a communicable disease, this sense of urgency for there to be an all hands on deck response to what's happening. But when it's not a communicable disease, when it's not like this acute situation, we haven't really, as a nation and as a country, risen to that same sense of urgency.

When you think about this stat, going from 9% to 49%, that's been happening in the -- I don't want to say in the background, because it is a very acute situation for the people who have been living through this. The folks who have lost mothers and brothers prematurely, people who have been -- Like, we spoke to a gentleman, Mr. Manuel, who is a union carpenter who helped build part of the World Trade Center, the Denver Airport. His health has deteriorated so bad that he's like, "I just want to enjoy my pension." You have these people who are integral parts of the integral fabric of the country whose health has really been deteriorating, and they are struggling. What COVID helped do is really magnify what has been happening that we really haven't been paying attention to probably the way that we should have.

Brian Lehrer: Yes. Policy responds and the media respond to things that are dramatic and sensational and sudden, rather than things that change slowly. It's one of the reasons we do a climate story of the week on the show every week all this year. In fact, folks, that's going to be the next segment coming up after this for this week. It's because the climate doesn't change at the speed of the news cycle. Things that are more immediate and more out of the blue, even if they represent underlying chronic conditions, that's what gets attention of the media, that's what gets the attention of policymakers, and so articles like yours are so important to draw some attention to things that change slowly.

It's like if a plane crashes and 300 people die, it makes huge headlines and everybody talks about it, "Oh my goodness, what are we going to do about this?" But when so many more people than that every year die in car crashes, but they happen one by one by one, we don't pay the same attention. Mary Allen in Inwood, you're on WNYC. Hello, Mary Allen.

Mary Allen: Hi, Brian. Thanks for taking my call. Hello, I have a question as far as life expectancy between male and female bodies, but not generally for healthy people. I'm talking about people who have cancer, who have COVID, heart disease issues, but with a twist. For example, I learned during COVID that mice in labs were predominantly male, and the reason was because they didn't want to do studies on female mice because their bodies are different, they have menstrual cycles, they have hormonal shifts and ranges throughout each month, so they would focus on male mice and male studies. How, as far as life expectancy, when the science is beginning to transition into more female research, how is that going to affect life expectancy between the two sexes?

Brian Lehrer: Great question. I'll just mention that we were recently talking about that fact on the show, that even animal studies in the lab tend to be done more on male rodents, as part of the research for the new book on exactly that topic by Cat Bohannon. I recommend people to that book if you want to know more about that. Akilah, to the caller's question.

Akilah Johnson: In general, what we see is there is a difference in terms of life expectancy between men and women. Men tend to have lower life expectancy than women do. Researchers posit a whole host of reasons and rationales, but to the caller's point, more and more researchers are beginning to acknowledge that when you look at clinical trials for things, when you look at studies for things, they are beginning to really understand the need to better understand biological differences in men and women and how that affects disease trajectory, and ultimately, how that disease trajectory, treatment trajectory, affects lifespan.

Brian Lehrer: Do you go to why the average life expectancy for -- I've got New York stats here -- for men in New York is 75, and it's 81 for women. It's a pretty big difference.

Akilah Johnson: It's a pretty big difference. It's not one of the areas we particularly explored in the study, but in speaking with some of the experts -- So, one of the experts that we quote, that I spoke to, runs a center for men's health equity, and one of the things that he quite often talks about are the different ways that men and women are socialized to think about their health, and the effect that that ultimately has on how people take care of their health and deal with their health.

I'm speaking in the broadest brush now, so I'm going to do some generalizations. I want to make sure that that caveat is understood. We tend to think in terms of -- When we think of stress and how we cope with stress, stereotypically, men might cope with stress through drinking, and that is like an acceptable thing, or drug use, or women might cope with stress through eating. Also, just psychosocially, men tend to not talk about what they're dealing with, not talk about emotions or talk about feelings [unintelligible 00:18:24] things, and that also then can become a barrier to seeking help, seeking care.

So, if you feel a little ill, if something is going wrong, you might not go to the doctor as frequently. You might not stay on top of your diabetes routine, in part because you're socialized to toughen up, to deal with it on your own, to not really seek help, seek care, seek community. Whereas women are more socialized to do those things, and so they are more likely to reach out. Those are just some of the ways we are socialized to think about health and and access care, and that ultimately can have a -- There are some biological differences as well that researchers are getting into in terms of hormones and the way that affects health, but honestly, quite a bit of it is socialization.

Brian Lehrer: Yes. With all the longitudinal data, meaning data over time that you have in this article, did you happen to come across whether the gender death gap has changed over the decades, widened or shrunk, or stayed the same? Did you happen to come across that?

Akilah Johnson: We looked at that, and I don't have it off the top of my head in terms of -- You know, when I say stay the same, I mean that in the broadest brush, and that the gap still exists. There may have been moments where it has shrunk and then moments where it has expanded, but at the end of the day, the gap remains.

Brian Lehrer: Yes, but 100 years ago, this gap existed too more or less is what you're saying.

Akilah Johnson: Yes.

Brian Lehrer: Carlos in the Bronx, you're on WNYC with Akilah Johnson from The Washington Post. Hi, Carlos.

Carlos: Hi, how are you? I guess I just want to make a comment and a question for the guest regarding the connection between big business like agribusiness, the healthcare pharma companies, the bioscience companies, and government, and how that cozy connection plays a role in these chronic illnesses that plague us. Whether it's financial support, political support for groups like multinational agro companies that produce a lot of corn surplus that's then turned into everything we consume, or it's placed in everything we consume in the form of things like high fructose corn syrup.

Or an industry like healthcare, which is a curious oxymoron, where the goal is to create a pill that makes a $1 billion so they can sell it to us, given the results, the healthcare results of eating the poor nutritional diet that many, many, many Americans, far too many consume each and every day. The lack of information, all these commercials that promote soda, and just nutritionally barren "food products." What do you see as the connection there in this topic that you're discussing today?

Brian Lehrer: Thank you, Carlos. Akilah?

Akilah Johnson: The caller is right on point. So many of our experts [unintelligible 00:22:02] brought up the fact that in this country, we tend to conflate health with medicine, and that particularly amongst our peer nations, the way we think about health is just radically different. We tend to think about health through the lens of medicine, so if there is a pill that we can take, an MRI that we can go do, so in a less holistic sense and a much more targeted sense.

But you know that we also, throughout our series of stories, and we do have another tranche coming up later this month that more specifically focuses on the types of food that we eat in terms of processed food. One of my colleagues, she did a story really looking at the rise of what's known as fatty liver disease in kids. There's a stat that she has in here that's looking at what kids are eating, and how what kids are eating has changed radically in a generation, going from having very little ultra-processed food in the early 1980s, to now more than 67% in recent years. All of that absolutely plays a part in terms of what contributes to the health of our nation or the lack thereof.

Brian Lehrer: One more call. Frank in Howard Beach, Queens, you're on WNYC. Hello, Frank.

Frank: Hi, Brian. Good morning. I'd like to present the question regarding life expectancy versus college education. In a recent New York Times article, October 3rd, by Anne Case and Angus Deaton, they presented a very telling graph that shows life expectancy versus college education that's very, very telling. I wanted to ask the guest what she thought about that.

Brian Lehrer: Akilah?

Akilah Johnson: That week, I saw that graph, and it reminded me of part of the analysis that we had run in our overall project that also talks about the relationship between college education and life expectancy. Ultimately, what you find is that people who have college degrees live longer lives, in a nutshell. I also was struck by, and remain to be struck by, you know, college degrees -- I think it's only about a quarter of the nation, and I could be wrong about that, but I'm generalizing, that quarter of the nation has a college degree. That also gets into the widening gap in the inequality of who lives and who dies.

College degrees are a protective factor, and with that comes -- Speaking with various experts, they point out that the protective factors that come with a college degree are not just simply connected to income and how much money you make, and therefore the access that you may or may not have to health insurance. That also comes with the ability to think about the health information that you are getting, to be better consumers of health information and health literacy, and the way that that also contributes to health.

Brian Lehrer: Yes. Although one final stat, and then we're out of time. I noticed in the article that it says lifespans in the richest communities in America, so that would certainly largely be the most college educated communities in America, have kept inching upward, but lagged far behind comparable areas in Canada, France, and Japan, and the gap is widening. Even as the gap between rich and poor in terms of life expectancy widens in this country, even the richest Americans are lagging behind the richest people in other countries that we typically compare ourselves to. Is there an easy reason why?

Akilah Johnson: Easy, no. [chuckles] Nothing about this is easy. It goes back to this idea of how we think about health in the US. A couple of the experts that we talked to, one in particular, Elizabeth Bradley, who's the president of Vassar College, but she also is the co-author of a book, The American Health Care Paradox. In that book, they have a stat that I looked at right before I got on the show. It says that in our peer nations, for every dollar they spend on health, they spend $2 on social services. In the US, for every dollar we spend on health, we spend 60 cents on social services.

When we think of the social safety net and our social determinants of health, in this country, we tend to think of that through a very narrow lens, almost with a pejorative angle to it, a lot of experts point out. But our social determinants of health and the social safety net just means kind of everything in terms of how you live, how the system works for you. And absolutely, people who have more money in this country, the system works better for them. In our peer nations, there is more of a universal understanding that things like secure housing, drinking water, safety, access to healthcare, access to your prescriptions, those are universal rights. In this country, they are not, and so we went from being in the middle of the pack when it comes to life expectancy in our peer nations to being last. We are now at the bottom of the pack.

Brian Lehrer: Akilah Johnson, reporter for The Washington Post focused specifically on the effect of racism and social inequality on health, and a contributor to this Washington Post deep dive on life expectancy in the United States over time and across different groups and different states today. Akilah, thank you so much for sharing this with us.

Akilah Johnson: I appreciate you having me. I enjoyed the conversation.

Copyright © 2023 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.